=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558719112
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FINANCIAL THERAPY ASSOCIATES OF DALLAS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2016
-----------------------------------------------------
Last Update Date | 05/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1701 N COLLINS BLVD SUITE 115
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-3564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-429-3774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 705 O PHELAN LN
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75044-3458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-429-3774
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/FINANCIAL THERAPIST
-----------------------------------------------------
Name | SHELLEE HENSON
-----------------------------------------------------
Credential | MS, LMFT-ASSOCIATE
-----------------------------------------------------
Telephone | 214-429-3774
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 202293
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------